See below for an example of a drop-down template for ultrasound-guided emergency nerve block. This is what we now use at Highland. Further down there is a generic checklist; it basically covers the basics of a safe ED block. The documentation sheet relates more toward the technical details of a safe block.

Patient was [was not] identiﬁed, using 2 criteria

After explanation of the risks benefits and alternatives verbal [written] consent was obtained.

Pre-procedure neurological exam findings:

A neurologic exam was conducted including motor and sensory testing of the [free text] nerve. There were no deficits. [The following deficits were found: [free text]]. Extremity compartments were [soft, tense, not assessed].

Procedural details:

The patient was [was not] maintained on continuous cardiac and pulmonary monitoring throughout the procedure.